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Table 3 Feedback from participants and facilitators

From: Reducing weight gain in people with schizophrenia, schizoaffective disorder, and first episode psychosis: describing the process of developing the STructured lifestyle Education for People With SchizophrEnia (STEPWISE) intervention

Cohort no.

No. of participants

No. of facilitators

Conducted by:

Emergent themes

Cohort 1

n = 2 (focus group)

n = 3 (Focus group)

1× independent

interviewer; 1× scribe

Participants:

o Transport a problem—had to catch two buses to get to the venue. Own mental health can get in the way of attending.

o Start of the session is ideal—allows time to get to the venue.

o Venue convenient to get to, compared to being in town.

o All felt comfortable in the group setting.

o Liked that they had the chance to learn to lose weight.

o Felt happy sharing information.

o Some session made them think about what to change.

o Booklet difficult to use (both participants dyslexic), especially the sections where they had to write down information.

o Some information seemed repetitive.

o Learned new information.

o Liked how the information was presented on flipcharts and put on the wall.

o Incentives (like the pedometer) helped with their confidence to manage their weight.

Facilitators:

o Concerns about how their time delivering the programme would impact on their other work.

o Whole programme felt rushed.

o Are sessions too long for participants?

o Many queries around organisational support of facilitators.

Cohort 2

–*

n = 1 (1:1 interview)

1× independent

interviewer

Facilitators:

o Felt relaxed and comfortable to deliver.

o Curriculum easy to follow.

o Still tricky to use the resources.

o Noted Next Steps session was too much for one patient in the group—information overload?

o Session 2—only one person attend, so activity is difficult to carry out.

o Should be a facilitator in reserve in case of an emergency (when facilitator becomes unavailable).

o Pleased with the venue.

o Storage of resources at the venue potentially an issue.

o Incentives a good idea.

o Believed intervention should be prescribed like a medication is prescribed. Need for it.

Cohort 3

n = 4 (focus group)

n = 1 (1:1 interview)

1× independent

interviewer; 1 scribe (focus group only)

Participants:

o Taxis made it convenient to get to the venue. Three participants emphasised how important this was to them attending and attending on time.

o Hesitant at first coming to a group, but like it because people understood them, it was not awkward, no one made them feel bad, it was a small group, and people listened.

o Liked consistency of same people delivering. Not having to worry about what people think of them helped them continue to attend. Liked that trained people with delivering. Liked that the group was non-compulsory to attend.

o Liked the idea of having a leaflet for people before they sign up to attend, to mention the key good points about the course.

o Did not want accompanying people to attend too—wanted to do something for themselves, would make the group that much larger, and would not want to share information with accompanying people.

o Information was the right amount—no overload. Wanted more than 4 sessions, up to 10 maybe?

o Duration of sessions good—did not want them to be any longer. Liked having a break. Liked lunch, but would have come even if there had not been lunch.

o Learned a lot, such as calorie content, benefits of taking more exercise, made you think how to manage yourself, and made you reflect. Enjoyed it.

o Liked sessions 3 and 4 best, because of learning about main meals and how to get support outside of the group.

o Would have preferred the same two people delivering for the whole course. They become part of the group. Hard to keep opening up to new people every week.

o Liked getting ideas from each other.

o Enjoyed the incentives.

o Changes made: small changes between sessions. Became more aware when shopping. Avoided certain foods. Kept their eye on things—healthier lifestyle.

o Wanted more information on how to think and change their attitude.

Facilitators:

o Harder delivering to larger group.

o New facilitator nervous at delivering and not very confident.

o Lack of tie for preparation.

o Lunch seems to motivate attendance.

o Would be good to book transport to avoid excluding people who cannot attend without support. More time to explore participants’ questions.

o Training for dealing the questions not covered in the curriculum.

o Lack of clarity about responsibility for preparing the room and managing the refreshment arrangements.

Cohort 4

n = 5 (focus group)

n = 1 (1:1 interview)

1× independent

interviewer; 1 scribe (focus group only)

Participants:

o Taxis really useful—otherwise would have had to take 1–2 buses

o Felt a bit agitated at first because of the size of the group—preferred a group of 6–7

o But did not feel pressured to speak or take part

o Duration of course OK but wanted more than 4 weeks. Maybe 6 weeks and a refresher every 6 months

o Session length long enough.

o Very positive about lunch, meant they did not have to rush to eat before leaving home.

o Supporting tools (incentives) very helpful

o Liked that there was not much writing in the sessions

o Wanted to learn how to manage diet and medication together

o Things learned: re-think view of diet and exercise; more about exercise and ways to move forward; frequency, amount, and type, learning to count calories.

o Have a leaflet before attending the sessions. Could not remember what they were told by referrers. Include content of sessions and quotes from people who have attended.

o No accompanying person, wanted to attend on their own. Also hard to talk about mental illness with accompanying person in the room.

Facilitators:

o More confident to deliver having done a few sessions already.

o Bigger group hard work, but sharing between group members better when group is larger.

o Curriculum is useful.

o Taxi provision is helping participants attend.

o Still some organisation issues with transport.

o Not enough time allowed to facilitators to prepare for sessions.

Booster session

n = 4 (focus group)

–**

1× independent

Interviewer

Participants:

o Pleased to be back.

o Positive impact of previous sessions—coming back was an encouragement

o Good to have prompts and group discussion

o Actions made since last session—thinking about what had been learnt when going shopping; looking out for things with less calories and less fat.

o Liked Keeping it Going and Action Plan sessions

o Duration of booster ‘adequate’

o Would have liked more food samples for food activity

o Would have liked pre-made recipe of meals talked about in food activity to take away

o Wanted more on exercise in next booster—specifically types of exercise that could be done at home or which did not cost much. Alternatives to going to the gym.

o Liked relaxed atmosphere of the session.

o Suggested adding in a day out to a park or to a gym, instead of going on their own.

  1. *All three participant did not attend sessions 3 and 4, so no feedback was taken
  2. **This session was delivered by members of the development team